CE-2011-00150_0001.tif 0f
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
® Building Permit Application (402)426- 4191 -Phone
(402) 426 -4195 - FAX
CE- 2011 -00150 1O M /se of ago www.blairnebraska.org
i
0510412011 bpeterse CURB -EXC Residential May 4, 2011
LOCATIONOFIMPROVEMENT: 2232 Clark St, Blair, NE 68008
ARCHITECT: GENERAL Platte Mechanical Inc.
6 OWNER: Robert E And Malinda J Jepsen CONTRACTOR: 600 Factory St
1824 Colfax St Fremont, NE 68025
BLAIR, NE 68008 -0000
i
i
N 6
NATURE OF WORK PROPOSED USE
Sub -Work New Const Primary Residence
PROJECT NAME PERMIT EXPIRES 05/03/2013
2232CIarkSt- 101008 -New Residential ESTIMATED COMPLETION DATE
2012 -05 -04
i
DESCRIPTION OF WORK
Excavation for the plumbing. Water and Sewer tie in.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
NA
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
N/A
I
w
i
1. No work will be started before a permit is ISSUED AND POSTED.
2. For commercial permits, a set of plans for this project must be submitted to the Nebraska State Fire Marshal's Office for review.
3. Separate permits are required for electrical, plumbing, heating, ventilating and air conditioning, and septic system.
I
4. The undersigned owner or agent understands and acknowledges this building permit application does not constitute issuance of
this building permit. It is further understood that construction covered by this permit application shall not be commenced until a
copy of a permit signed by the Building Inspector is issued.
5. The undersigned owner or agent agrees to perform the proposed work in accordance with the specifications set forth above and
in accordance with the codes /ordinances of the City of Blair and the State of Nebraska. Any omission of or misrepresentation of
fact with or without the intention of the undersigned or any alteration or change from this application without approval of the
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
pplication.
Signature&I Applicant Da e